Negative-Pressure Wound Therapy in a Patient with Osteomyelitis Caused by Multidrug-Resistant Bacterial Infection: A Case Report

Yoon Taekeun,Kim Sang Wha 대한창상학회 2021 Journal of Wound Management and Research Vol.17 No.3

Uncontrolled infection, especially with multidrug-resistant bacteria, may significantly inhibit wound healing. Although negative-pressure wound therapy can help prevent infection, it is contraindicated in patients with untreated infections, including osteomyelitis. Here, we report successful wound healing by negative-pressure wound therapy in a patient with refractory osteomyelitis due to multiple multidrug-resistant bacterial infections. Soft tissue infection and osteomyelitis progressed deeply through subcutaneous tunneling; hence, bacteria were not excreted from the affected area. Negative-pressure wound therapy reduced the bacterial load and resolved the patient’s condition. Healing by secondary intention progressed with subsequent formation of granulation tissue. Despite recommendations against negative-pressure wound therapy in patients with osteomyelitis, this study highlights the application of the technique for infection control in patients with multidrug-resistant bacterial infections and osteomyelitis.

Case Report : Negative-Pressure Therapy for Pre-and Post-grafting after Wide Extirpation Excision of Melanoma of the Toe

( Jong Hoon Kim ),( Mi Ryung Roh ),( Kyoung Ae Nam ),( Hyun Joong Jee ),( Hoon Bum Lee ),( Kee Yang Chung ) 대한피부과학회 2013 大韓皮膚科學會誌 Vol.51 No.1

Surgical management of acral lentiginous melanoma on the toe poses a difficult challenge because of the lack of surrounding tissue. A full-thickness skin graft after excision may provide a good cosmetic outcome, but graft failure can occur due to limited blood flow of the toe and the thin skin covering over the deep fascia in the pressure bearing area may cause gait disturbance. A negative-pressure device can be beneficial for fixing the graft and stimulating the growth of granulation tissue. A 55-year-old woman diagnosed with malignant melanoma on the right third toe underwent wide excision, after which secondary intention healing was initiated using negative-pressure therapy. When the wound had regenerated enough granulation tissue after 2 weeks, a full-thickness skin graft was performed, which was secured with negative-pressure therapy. The graft was successfully taken after a week thereafter. Accordingly, the use of negative-pressure therapy in the surgical management of acral lentiginous melanoma may be a good option because it facilitates full-thickness skin graft survival in an avascular surface area and aids in the thickening of the pressure bearing area, where acral lentiginous melanoma is likely to occur. (Korean J Dermatol 2013;51(1):65∼68)

음압 창상 처치(Negative pressure wound therapy)에 대한 문헌적 고찰

유주리,강재경,You, Ju Lee,Kang, Jae Kyoung 제주대학교 의과학연구소 2018 The Journal of Medicine and Life Science Vol.15 No.2

NPWT는 90년대 이후 많은 연구가 이루어지며 발전해왔다. 이 기술은 사용하기에 간단하고 다양한 상처에 적용할 수 있고 효용성과 비용-효과가 뛰어나며 부작용이 적다. 따라서 NPWT를 일반적인 드레싱 대신에 사용하면 육아조직의 빠른 성장과 상처 수축을 통해 피부 이식이나 피판이 필요한 부위를 줄일 수 있고 봉합이 불가했던 부위를 가능하게 하므로 창상 환자에 대한 의료 비용을 감소시키고 만성 창상 환자가 입원하지 않고 움직이면서 창상 관리가 가능하도록 할 수 있는 유용한 방법이다. Advances in medical technology has enabled better management of complicated and chronic wounds. Negative-pressure wound therapy (NPWT) is a novel dressing technique that uses negative pressure to drain exudates and blood from wounds. NPWT increases local blood flow and promotes reduction of edema and wound healing and is suitable for a variety of wounds. It is associated with few adverse effects and shows excellent efficacy and cost-effectiveness. NPWT promotes rapid growth of granulation tissue and wound contraction; thus, it is more advantageous than general dressings as it reduces the size skin of grafts or flaps required for repair, and patients with chronic wounds can be treated as outpatients. We investigated the general usage and mechanism of NPWT, its clinical applications and adverse effects.

Negative Pressure Wound Therapy of Chronically Infected Wounds Using 1% Acetic Acid Irrigation

정희선,이병호,이혜경,김형석,문민선,서인석 대한성형외과학회 2015 Archives of Plastic Surgery Vol.42 No.1

Background Negative-pressure wound therapy (NPWT) induces angiogenesis and collagen synthesis to promote tissue healing. Although acetic acid soaks normalize alkali wound conditions to raise tissue oxygen saturation and deconstruct the biofilms of chronic wounds, frequent dressing changes are required. Methods Combined use of NPWT and acetic acid irrigation was assessed in the treatment of chronic wounds, instilling acetic acid solution (1%) beneath polyurethane membranes twice daily for three weeks under continuous pressure (125 mm Hg). Clinical photographs, pH levels, cultures, and debrided fragments of wounds were obtained pre- and posttreatment. Tissue immunostaining (CD31, Ki-67, and CD45) and reverse transcription-polymerase chain reaction (vascular endothelial growth factor [VEGF], vascular endothelial growth factor receptor [VEGFR]; procollagen; hypoxia-inducible factor 1 alpha [HIF-1-alpha]; matrix metalloproteinase [MMP]- 1,-3,-9; and tissue inhibitor of metalloproteinase [TIMP]) were also performed. Results Wound sizes tended to diminish with the combined therapy, accompanied by drops in wound pH (weakly acidic or neutral) and less evidence of infection. CD31 and Ki-67 immunostaining increased (P<0.05) post-treatment, as did the levels of VEGFR, procollagen, and MMP-1 (P<0.05), whereas the VEGF, HIF-1-alpha, and MMP-9/TIMP levels declined (P<0.05). Conclusions By combining acetic acid irrigation with negative-pressure dressings, both the pH and the size of chronic wounds can be reduced and infections be controlled. This approach may enhance angiogenesis and collagen synthesis in wounds, restoring the extracellular matrix.

족관절 화농성 관절염이 동반된 난치성 외과 점액낭염의 음압 창상치료: 증례 보고

김지연,장지훈,정소학,Kim, Jiyoun,Jang, Jihoon,Chung, So Hak 대한족부족관절학회 2021 대한족부족관절학회지 Vol.25 No.4

A bursa is an obstructive sac filled with synovial fluid and usually occurs in any area of the body exposed to friction. The bursa of the ankle is not a normal anatomical structure and is caused by repetitive trauma, constant friction, or inflammatory disease of the ankle. Bursitis can occur in any bursa in the human body; however it rarely progresses to septic arthritis. We report a rare case of septic ankle arthritis following intractable lateral malleolar bursitis successfully treated with negative-pressure wound therapy.

A single-use negative-pressure wound therapy device can reduce mastectomy skin flap necrosis in direct-to-implant breast reconstruction

Ji Hun Kim,김윤상,Yang Woo Kim,김유진,전용순,Heung Kyu Park,전영우 대한미용성형외과학회 2020 Archives of Aesthetic Plastic Surgery Vol.26 No.1

Background Mastectomy flap necrosis is a common and challenging complication of direct-to-implant (DTI) breast reconstruction. The PICO single-use negative-pressure wound therapy device may reduce the complications associated with skin flap necrosis. We evaluated the relationship between PICO use and the incidence of mild, moderate, and severe skin flap necrosis in patients at high risk of necrosis. Methods Using medical records from January 2015 to March 2019, we retrospectively analyzed patients who underwent DTI breast reconstruction after oncological breast surgery at a single institution and identified those at high risk for skin flap necrosis. During this period, PICO was used selectively for patients deemed to be at particularly high risk. Patient demographics, operative characteristics, and the degree of skin flap necrosis were compared according to whether PICO was used. Results Of 117 patients (122 breasts), 45 were deemed to be at high risk of skin flap necrosis. PICO was applied to 38 of these breasts, and seven breasts received a conventional dressing. Skin flap necrosis occurred in 30 breasts (24 in the PICO group [63.2%] vs. 6 in the no-PICO group [85.7%]). Significantly fewer cases of severe skin flap necrosis were observed in the PICO group (2/38 [5.3%]) than in the no-PICO group (3/7 [42.9%]) (P=0.004). There were no significant between-group differences in outcomes measured using BREAST-Q scores. Conclusions Use of a single-use negative-pressure wound therapy device can reduce the risk of severe skin flap necrosis in patients at high risk of skin flap complications associated with DTI breast reconstruction.

Negative Pressure Wound Therapy of Chronically Infected Wounds Using 1% Acetic Acid Irrigation

Jeong, Hii Sun,Lee, Byeong Ho,Lee, Hye Kyung,Kim, Hyoung Suk,Moon, Min Seon,Suh, In Suck Korean Society of Plastic and Reconstructive Surge 2015 Archives of Plastic Surgery Vol.42 No.1

Background Negative-pressure wound therapy (NPWT) induces angiogenesis and collagen synthesis to promote tissue healing. Although acetic acid soaks normalize alkali wound conditions to raise tissue oxygen saturation and deconstruct the biofilms of chronic wounds, frequent dressing changes are required. Methods Combined use of NPWT and acetic acid irrigation was assessed in the treatment of chronic wounds, instilling acetic acid solution (1%) beneath polyurethane membranes twice daily for three weeks under continuous pressure (125 mm Hg). Clinical photographs, pH levels, cultures, and debrided fragments of wounds were obtained pre- and posttreatment. Tissue immunostaining (CD31, Ki-67, and CD45) and reverse transcription-polymerase chain reaction (vascular endothelial growth factor [VEGF], vascular endothelial growth factor receptor [VEGFR]; procollagen; hypoxia-inducible factor 1 alpha [HIF-1-alpha]; matrix metalloproteinase [MMP]-1,-3,-9; and tissue inhibitor of metalloproteinase [TIMP]) were also performed. Results Wound sizes tended to diminish with the combined therapy, accompanied by drops in wound pH (weakly acidic or neutral) and less evidence of infection. CD31 and Ki-67 immunostaining increased (P<0.05) post-treatment, as did the levels of VEGFR, procollagen, and MMP-1 (P<0.05), whereas the VEGF, HIF-1-alpha, and MMP-9/TIMP levels declined (P<0.05). Conclusions By combining acetic acid irrigation with negative-pressure dressings, both the pH and the size of chronic wounds can be reduced and infections be controlled. This approach may enhance angiogenesis and collagen synthesis in wounds, restoring the extracellular matrix.

만성 창상의 치료에서 이동식 음압요법의 신고안

김지수,윤인모,유중석 대한성형외과학회 2008 Archives of Plastic Surgery Vol.35 No.2

Purpose: V.A.C. is a new concept which is closed dressing with negative pressure to promote wound healing. It has been widely used as the treatment of chronic and acute wounds such as pressure sores, burns, stasis ulcers, and other complicated wounds. However It has disadvantages such as high cost and the need of specific equipment. In this article, we described new method to overcome these disadvantages.Methods: We made newly innovated equipment with 50cc syringe and spring to create negative pressure. From May 2006 to May 2007, we applied it to two patients with chronic wound. Results: The treatment period was 5 weeks for one case and 3 weeks for the other case. Both patients were healed completely without admission and wound healing was accelerated. During follow-ups, there were no complications. The mean cost for single dressing was 9,590 won. Conclusion: Modified portable negative therapy using newly innovated equipment could accelerate wound healing better than conventional dressing. It lowers the number of dressings, saves cost of treatment, and enables treatment as outpatient basis.

Clinical Outcomes of Negative-Pressure Wound Therapy with Instillation without Commercial Devices in the Treatment of Complex Wounds

Sung Ji Yoon,배용찬,남수봉,김주형 대한창상학회 2020 Journal of Wound Management and Research Vol.16 No.1

Background: Negative-pressure wound therapy with instillation (NPWTi) is an adjunctive treatment modality for complex and infected wounds. However, commercial devices are expensive and not readily available in many countries. The objective of this study is to introduce an NPWTi method that is applicable where commercial NPWTi devices are not available and to report the clinical outcomes of the NPWTi method for the adjunctive treatment of complex wounds.Methods: This prospective clinical experimental study included 51 patients who had wounds on which operative debridement was performed between January 2017 and March 2019. A negative-pressure wound therapy (NPWT) device was applied with an intravenous (IV) line for continuous instillation of 0.9% normal saline plus 1% povidone-iodine solution for chronic wounds. The outcomes measured were the number of operating room visits, time to final surgical procedure, number of infected wounds, time to resolution of infection, type of reconstruction operation, and occurrence of complications.Results: The average number of operations performed was 2.5±0.8, and the time to final surgical procedure was 28.4±15.4 days. The number of infected wounds was 35 (68.6%), and the time to resolution of infection was 15.0±14.6 days. All wounds were closed or covered. Though partial graft failure occurred in two cases, they healed completely by secondary healing in 2 weeks.Conclusion: A continuous-instillation NPWT system using an IV line could be an adjunctive modality in treating complex wounds at institutions where commercial NPWTi systems are not readily available.

습부항이 혈액학적 성상에 미치는 영향에 대한 연구

송봉근,박승원,김중길,김요한,이시우,정인석,Song, Bong-Keun,Park, Seug-Won,Kim, Joong-Kil,Kim, Yo-Han,Lee, Si-Woo,Jeong, In-Seok 대한한방내과학회 2001 大韓韓方內科學會誌 Vol.22 No.4

Objectives: We examined if their hematological status could be changed by blood loss in patients treated with bleeding pressure therapy. Methods: The patients were divided into two groups as follows: The Subject group(B) were 42 cases treated with bleeding pressure therapy. The Control group(N) were 43 cases treated with negative bleeding pressure therapy, We checked CBC & differ cell count of two groups. Results: The means of RBC, Hb count and Hct were slightly decreased after 1 week. but they were recovered after 2 weeks. Conclusions: These results indicate that Bleeding Pressure Therapy don't reduced RBC, Hb count and Hct in Patients.